Epidural Steroid Injections Linked to Bone Fractures

Patients treated with epidural steroid injections for back pain are at increased risk of bone fractures, according to a new study conducted at Henry Ford Hospital in Detroit. Researchers say the risk of a spinal fracture increases 29 percent with each steroid injection.

“For a patient population already at risk for bone fractures, steroid injections carry a greater risk that previously thought and actually pose a hazard to the bone,” said lead author Shlomo Mandel, MD, a Henry Ford orthopedic physician.

Mandel recommends that patients being treated with steroid injections be told about the risk of fractures and undergo bone testing.

Bone fractures in the spine are the most common fracture in patients with osteoporosis. About 10 million Americans suffer from osteoporosis, which is caused by a decline in mineral bone density. About half of all women and a quarter of all men over the age of 50 will break a bone due to osteoporosis.

Patients are typically treated with anti-inflammatory drugs, painkillers and physical therapy. But if symptoms persist, an epidural steroid is often prescribed to alleviate pain.

Nearly nine million epidural steroid injections were performed in the U.S. last year. Although complications are rare, the procedure is coming under more scrutiny because of a recent outbreak of fungal meningitis caused by a contaminated steroid.

In the Henry Ford study, researchers compared data for 6,000 patients who were treated for back pain between 2007 and 2010. Half of the patients received at least one steroid injection and the other half received no injection. Researchers analyzed the incidence of bone fractures in each group and found that the number of steroid injections is linked with an increased likelihood of fracture.

The study was accepted as a Best Paper at the annual meeting of the North American Spine Society. It has not yet been published or been peer reviewed.